In the November issue of the Annals of Emergency Medicine, the American College of Emergency Physicians published a clinical policy focusing on critical issues in the emergency department management of adult patients presenting with community-acquired pneumonia (CAP). This is the first revision of a policy on CAP that was initially published in 2001.

This clinical policy can also be found on ACEP’s Web site, www.acep.org, and will be abstracted on the National Guideline Clearinghouse Web site, www.guidelines.gov.

This clinical policy takes an evidence-based approach to answering two frequently encountered questions.

This clinical policy takes an evidence-based approach to answering two frequently encountered questions related to emergency department decision making. Recommendations (Level A, B, or C) for patient management are provided based on the strength of evidence using the Clinical Policies Committee’s well-established methodology:

• Level A recommendations represent patient management principles that reflect a high degree of clinical certainty.
• Level B recommendations represent patient management principles that reflect moderate clinical certainty.
• Level C recommendations represent other patient management strategies based on preliminary, inconclusive, or conflicting evidence, or based on consensus of the members of the Clinical Policies Committee.

During development, this clinical policy was reviewed by individual emergency physicians and by individual members of the American College of Chest Physicians, the American College of Physicians, the Infectious Diseases Society of America, the Institute for Clinical Systems Improvement, the Society for Academic Emergency Medicine, and ACEP’s Section on Critical Care Medicine. Their responses were used to refine and enhance this policy; however, their responses do not imply endorsement of this clinical policy.

CAP is a major health problem in the United States, with a price tag of nearly $9 billion and an age-adjusted mortality rate of up to 22%. CAP has been recently redefined as an acute pulmonary infection in a patient who has been neither hospitalized nor living in a long-term care facility 14 or more days before presentation. Mortality rates have not improved significantly during the decades for which data are available.

Current quality and performance measures outlining strict time-to-antibiotic goals are not only difficult to achieve in overcrowded emergency departments, but also can lead to treatment without diagnostic confirmation.

The new ACEP clinical policy on CAP addresses these issues and how emergency practitioners can best manage CAP, as most patients with CAP initially present to the emergency department.